降钙素原和sTREM-1对急性胰腺炎严重程度的早期预测价值

发布时间：2018-04-30 02:22

  本文选题：胰腺炎 + 降钙素原　； 参考：《中南大学》2013年博士论文

【摘要】：目的：通过检测血清降钙素原(procalcitonin, PCT)及可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cells-1, sTREM-1)的水平,并监测其动态变化,探讨上述两个炎症标记物在急性胰腺炎(acute pancreatitis, AP)严重程度早期评估中的临床意义,确定PCT诊断重症急性胰腺炎(severe acute pancreatitis, SAP)的最佳界值参数,并初步分析两指标的相关性,比较各预测方法对SAP的诊断效能。 方法：收集2012年8月至12月在湘雅医院住院的确诊AP患者34例,分为轻症急性胰腺炎(mild acute pancreatitis, MAP)组(16例)和SAP组(18例),同时随机选取20例体检健康者作为对照组。分别测定AP患者在入院后第1天、4天、7天的血清PCT及sTREM-1浓度,并进行急性生理学及慢性健康状况评分(acute phsiology and chronic health evalution score Ⅱ, APACHE Ⅱ)、CT严重度指数(computed tomography severity index, CTSI)评分及床旁急性胰腺炎严重度(bedside index for severity in acute pancreatitis, BISAP)评分,健康个体采血3ml检测血清PCT及sTREM-1浓度。各组间进行比较分析。 结果： (1)入院7天内,SAP组血清PCT浓度明显高于同期MAP组(P0.001)；在诊断界值取1.56ng/ml时,PCT诊断SAP的敏感性为88.9%、特异性为100%。 (2)SAP患者入院后第1天的血清sTREM-1浓度高于MAP组(P0.005)和正常对照组(P0.001),MAP组高于正常对照组(P0.001)；SAP组与MAP组血清sTREM-1浓度在入院7天内的同一时间节点均有显著差异(P0.05)；sTREM-1浓度与APACHE II评分、CTSI评分及BISAP评分均呈正相关(P0.05)；以0.41ng/ml为界时sTREM-1诊断SAP的敏感性为66.7%、特异性为93.8%。 (3)非参数等级相关分析显示,AP患者血清PCT和sTREM-1表达水平呈正相关(相关系数r=0.471,P0.01)。 (4)绘制受试者工作特征曲线,计算曲线下面积(area under the curve, AUC)可见,与APACHE II(AUC=0.882)、sTREM-1(AUC=0.839)相比,降钙素原(AUC=0.96)对SAP的诊断效能最大。 结论： (1)血清PCT是早期预测SAP的理想指标,诊断界值为1.56ng/ml时其对SAP的诊断效能最大。 (2)血清sTREM-1与AP严重程度相关,可作为AP病情早期预测的参考指标。 (3)血清PCT和sTREM-1参与了AP的炎症反应过程,在AP发病过程中呈正相关。
[Abstract]:Objective: to detect the levels of procalcitonin (PCT) and soluble myeloid cell trigger receptor -1soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum and their dynamic changes. To investigate the clinical significance of the above two inflammatory markers in the early assessment of acute pancreatitis (AP) severity, to determine the optimal threshold parameters for the diagnosis of severe acute pancreatitis, SAP) by PCT, and to preliminarily analyze the correlation between the two indexes. The diagnostic effectiveness of each prediction method for SAP was compared. Methods: Thirty-four patients with AP in Xiangya Hospital from August to December 2012 were divided into mild acute pancreatitis (acute pancreatitis, MAP) group (n = 16) and SAP group (n = 18). 20 healthy persons were randomly selected as control group. Serum PCT and sTREM-1 levels were measured in patients with AP on day 1 and day 4 and day 7 after admission, respectively. Acute phsiology and chronic health evalution score 鈪，

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